中上胸椎3D打印导板引导与徒手椎弓根钉置入比较△

3D printed guide assisted versus freehand pedicle screw fixation of upper and middle thoracic spine fractures

摘要:

[目的]评价 3D 打印导板辅助中上胸椎椎弓根钉置入准确性和意义。[方法]回顾性分析本院 2019 年 12 月—2022 年 12 月手术治疗的中上胸椎骨折 50 例患者的临床资料。依据术前医患沟通结果，25 例采用 3D 打印导板辅助置钉 （导板组），25 例采用传统徒手置钉（徒手组）。比较两组围手术期、随访及影像资料。[结果]50 例手术均顺利完成，术中未出现主动脉、胸髓及神经根损伤。导板组透视次数 [(2.8±1.2) 次 vs (9.5±2.7) 次, P＜0.001]、单钉置入时间 [(2.2±0.5) min vs (3.5±0.7) min, P＜ 0.001] 、一次置钉成功率（100.0% vs 90.7%, P＜0.001）均显著优于徒手组，但前者的医疗费用显著高于后者 [(35 221.4±423.2) 元 vs (34 358.5±442.9) 元, P＜0.001]。两组手术时间、切口总长度、术中出血量、住院时间的差异均无统计学意义（P＞0.05）。随访时间（16.8±3.4）个月，随时间推移，两组 VAS 评分、ODI 指数、JOA 评分及 ASIA 神经评级均显著改善（P＜0.05），相应时间点， 两组间上述指标的差异均无统计学意义（P＞0.05）。术后影像评估，导板组置钉精准率 [(0/I/II), (146/4/0) vs (122/23/5), P＜0.001] 显著优于徒手组，末次随访两组病例均骨性愈合，均无内固定物松动、断钉等。[结论]3D 打印导板辅助下行中上胸椎螺钉置入， 提高了椎弓根钉置入的精准性，患者射线暴露少，安全性更高。

Abstract:

[Objective] To evaluate the accuracy and significance of 3D printed guide assisted pedicle screw placement for fixation of the upper and middle thoracic spine fractures. [Methods] A retrospective study was performed on 50 patients who underwent surgical treatment for upper and middle thoracic spine fractures from December 2019 to December 2022. According to preoperative doctor-patient communication, 25 patients had screw placed by the 3D printed guides (the guide group), while the remaining 25 patients were managed by traditional freehand technique (the freehand group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] All the 50 patients were successfully operated without injuries to aorta, thoracic pulp and nerve root. The guide group proved significantly superior to the freehand group in terms of intraoperative fluoroscopy times [(2.8±1.2) times vs (9.5±2.7) times, P＜0.001], time of single screw placement [(2.2±0.5) min vs (3.5±0.7) min, P＜0.001], success rate of first time screw placement (100.0% vs 90.7%, P＜0.001), whereas the former consumed significantly higher medical fee than the latter [(35 221.4±423.2) yuan vs (34 358.5±442.9) yuan, P＜0.001]. However, there were no significant differences in operation time, total incision length, intraoperative blood loss and hospital stay between the two groups (P＞0.05). As time went on in follow-up period lasted for (16.8±3.4) months, the VAS, ODI and JOA scores, as well as ASIA neurological function classification significantly improved in both groups (P＜0.05), whereas which were not statistically significant between the two groups at any time points accordingly (P＞0.05). As result of postoperative imaging evaluation, the guide group was also proved significantly superior to the freehand group regarding screw placement accuracy [(0/I/II), (146/4/0) vs (122/23/5), P＜0.001]. At the last follow-up, all pa-tients in both groups got fracture healing without loosening of internal implants. [Conclusion] The 3D printed guide assisted pedicle screw placement for fixation of the upper and middle thoracic spine fractures does improves the accuracy with less radiation exposure and higher safety.